Uganda switches to HIV su­per drug do­lute­gravir

Ac­tivists say ex­clud­ing women of child­bear­ing age vi­o­lates their health rights

The East African - - OUT­LOOK - By EVE­LYN LIRRI Special Cor­re­spon­dent

As a safety mea­sure, only HIV pos­i­tive young girls un­der 14, menopausal women and those on long term fam­ily plan­ning meth­ods are el­i­gi­ble for DTG.”

Uganda is the lat­est African coun­try to switch to Do­lute­gravir (DTG) as the first line drug to treat HIV, but women of re­pro­duc­tive age will be ex­cluded from the reg­i­men over fears of po­ten­tial side effects on un­born ba­bies, ex­perts say.

De­vel­op­ing coun­tries, es­pe­cially in Africa, have been us­ing Efavirenz-based an­tiretro­vi­ral drugs as the preven­tion treat­ment op­tion for HIV, but many are now switch­ing to DTG be­cause of its su­pe­rior ben­e­fits.

DTG has fewer side effects, greater po­tency against drug re­sis­tance and sup­presses the viral load faster. A per­son whose viral load is sup­pressed has a re­duced risk of in­fect­ing their sex­ual part­ners.

The head of the Aids Con­trol Pro­gramme at Uganda’s Health Min­istry Dr Joshua Musin­guzi said the de­ci­sion to leave out women of re­pro­duc­tive age (14-49 years) is based on rec­om­men­da­tions from the World Health Or­gan­i­sa­tion, fol­low­ing pre­lim­i­nary re­sults of a study con­ducted in Botswana. The study found in­creased risk of birth de­fects in children born to Hiv-pos­i­tive women who were tak­ing DTG at the time of con­cep­tion.

Al­though the re­port is in­con­clu­sive, WHO rec­om­mended that women of child­bear­ing age, es­pe­cially those in the first few weeks of preg­nancy, should not take the drug.

“As a safety mea­sure, the min­istry de­cided that only Hiv-pos­i­tive girls un­der 14, menopausal women and those on long term fam­ily plan­ning meth­ods would be el­i­gi­ble for the new drug,” said Dr Musin­guzi.

The rest will con­tinue us­ing Efavirenz. All men will also be en­rolled on the new drug.

How­ever, health-rights ac­tivists say ex­clud­ing women from a drug with proven ben­e­fits is a vi­o­la­tion of their rights.

Martha Akello from the In­ter­na­tional Com­mu­nity of Women Liv­ing with Hiv/aids-east­ern Africa said a blan­ket ex­clu­sion of women in the child­bear­ing age group means po­ten­tial el­i­gi­ble women who would have oth­er­wise ben­e­fited from the drug will miss out.

“Not all women in the child­bear­ing

Joshua Musin­guzi, Min­istry of Health

age are in­ter­ested in hav­ing ba­bies while oth­ers al­ready have the num­ber of children they want. The Min­istry needs to look at this is­sue on a case by case ba­sis in­stead of plac­ing a to­tal ban,” said Ms Akello.

She said that in­stead, women should be coun­selled and given in­for­ma­tion about the drug and the po­ten­tial im­pact it could have, to en­able them to make in­formed choices on their own.

But Dr Musin­guzi said the gov­ern­ment’s de­ci­sion is in the best in­ter­est of women and their children.

“In set­ting health guide­lines for the coun­try, you use what is called the pub­lic ap­proach where you go for the com­mon good. So as a cut off, we have de­cided that only women out­side the re­pro­duc­tive age group will get the new drug,” he said.

He added that even though the study showed that the drug could be safe for use in the later stages of preg­nancy, the min­istry does not want to take chances.

“We don’t want back and forth is­sues in terms of plan­ning and also be­cause un­like the de­vel­oped world where health­care is in­di­vid­u­alised, our health fa­cil­i­ties may not have the ca­pac­ity to han­dle women with dif­fer­ent needs,” said Dr Musin­guzi.

The DTG roll­out will be con­ducted in a phased man­ner, start­ing this Septem­ber. All el­i­gi­ble peo­ple are ex­pected to have switched to the new drug by De­cem­ber 2019. The drug will cost an es­ti­mated $6.5 per per­son per month com­pared with the Efv-based com­bi­na­tion, which costs $6.9 per pa­tient.

There are an es­ti­mated 1.4 mil­lion Ugan­dans cur­rently on anti-retro­vi­ral ther­apy, ac­cord­ing to the lat­est Uganda Pop­u­la­tion-based HIV Im­pact As­sess­ment re­port.

Kenya, Nige­ria and Botswana, which were some of the first African coun­tries to switch to Do­lute­gravir, have also banned the use of the drug by women of re­pro­duc­tive age.

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